Lessons from my parents, the candid truth of the aged care home

These views are a reflection of the contributor and we believe it is important to give everyone a platform to share their opinion. 

I have written this paper for two main reasons.

The first is that I hope it will be a guide to improving the Aged Care facilities and their practices so that current and future residents can live their final years with more dignity and care than some of them are currently being given.

Any of us can find ourselves in the position of going into a Care facility at any time (without planning) and I surely hope that if or when I go there I will be afforded a lot more care and dignity than I have witnessed (and heard about) up until now.

The second reason is as a closure for me after years of advocating for my parents who are no longer with us.  I find writing a very therapeutic way of dealing with grief.

The headings I have chosen to write under are:

• Ethos:
• Advocacy:
• Communication:
• Meals
• Supervision:
• Training:
• Dementia training
• Demarcation:
• Empathy
• Community
• Accreditation
• Finances
• On the Positive side

At the end I have given recommendations from my perspective.  It is up to the facilities if they take any notice, but I do know that improvement is urgently needed.  Social media is full of unhappy comments and complaints.

My experience:

My parents went into an Aged Care Home in Cairns almost 4 years ago.

They lived in their own home before that with a support package and a lot of assistance from me, neighbours etc.  They really should have gone into an Aged Care Home before they did but were stubborn and refused to go.

Mum was afraid as she said that everyone that goes into one dies. Dad had advanced Parkinson’s Disease and Mum had dementia.  Mum was covering up for her disease very well, but I could see the signs that all was not as she portrayed it.

Neither drove a car anymore.

Dad had to surrender his after a couple of not-to-serious accidents.

Thank goodness that they were not worse.

This meant I was the driver.  However, I was also working and being a Mum and grandmother myself.

I was one of the Sandwich Generation except it was a Club Sandwich.

Multi layered.

I had pre-empted their move about 3 years earlier and registered them at the Aged Care facility that I knew they would want to go to if they were forced to.

They did not know about the registration.

This came in very handy when Mum had a terrible fall which broke the C2 in her neck in 3 places.

Fortunately, she had her emergency buzzer within reach.

She fell in the middle of the night.

We had also installed a key lock at their front door, so the Ambulance people were able to open the key lock with the code and then open the front door and let themselves in to come to Mum’s aid.

Dad was snoring away in his room.

They woke him to tell him what had happened.

Mum was, of course, taken to hospital.  Dad was able to move into Care a few days later in Respite.

Mum moved into the same facility when she was discharged from Hospital.

They were eventually able to have rooms opposite each other which was fantastic, and I am forever grateful.

I must say that I was not totally naive about Aged Care facilities as I have worked in a counselling role for many years and at one time was Locum Manager of Carers Queensland in my city, so had heard many stories and had supported people in the position that I now found myself in.

My grandparents and some Uncles and Aunts had also been in Aged Care facilities.

My careers have been in Nursing, Community Development and Management so I do have some insight.

However, I still had the belief in people and thought that Mum and Dad would be ok in this nice, well-renown facility.

What a lesson I learnt and what a rocky road we travelled although Mum was blissfully unaware of most of it.

I had a rocky road to travel but so did the Management of the facility as my Mum was a wonderful role-model to me in the past and had really taught me well in advocacy and speaking up.

I was taught well.

Dad was in the facility for 2 years and 7 months and Mum was there for 3 years and 8 months.

I was a very regular visitor and my daughter and her family were also.

In the last 7 months I was at the facility almost every day.  I sometimes went in the morning and played cards with Mum and then stayed for lunch (encouraging Mum to eat).

Other days I would go in the afternoon and stay for dinner.

Sitting next to Mum in the Dining Room, encouraging the ladies at the table to eat (and feeding one) gave me a good insight into the different issues and what was and was not being done for these people.

I went out of my way to get to know the ladies and gentlemen and to talk to them about things that I knew were important to them.

This way I formed a bond with them and grew to know them all quite well, even to the extent that I could tell the carers when they served the wrong meal to some of them.

Below are my observations about what are the issues that need addressing and some examples to highlight the need for change.

The big issues as I see them…

Ethos:

If the emphasis is on the tasks not the people, then we will never have a truly caring home for people who are in a very vulnerable and often sad position at the end of their life.

If the residents are put first and in the centre of everything that happens then the tasks will be achieved but in a much more caring way.

This can happen and has happened in large hospitals so can occur in an Aged Care facility, it just means a change of attitude and practice.

Resident Centred Care is an absolute must.

If this happens a lot of the other issues will disappear with the change.

The Victorian Department of Human Services (2003) defines person-centred care for older people as the “treatment and care provided by health services (that) places the person at the centre of their own care and considers the needs of the older person’s carers.”

Examples:

• I have heard remarks from some staff members such as “These people need to learn patience”. I suggest that it is the staff member who needed to learn patience.  Other remarks from staff such as “Oh bugger him, he always wants something, I am not here for his beck and call”.  I realise that some residents can be very demanding but that is part of the job, and the resident is paying to get that attention.  Quite often it is the resident’s medical condition that makes the resident angry, frustrated and sometimes quite aggressive.
• Leaving residents in wet and/or soiled incontinence aids because the PCW (Personal Care Worker) has other things to do is not in the Resident’s best interest. That is why UTIs (Urinary Tract Infection) and bedsores occur.  Would you like to eat in that condition? I am damn sure that I would not.

Advocacy

I have learnt that residents in Aged Care facilities need a strong advocate.

The residents are reluctant to speak up for fear of being labelled “Trouble-maker” and being given negative treatment.

Even relatives feel the same way.

I have spoken to many relatives of people in this facility as well as others who are angry or frustrated about something but will not speak up for fear of reprisals (and they have happened).

Quite often these relatives are also elderly (spouse) so are intimidated by authority.

Secret visitors (similar to Secret Shoppers) could assist in this area.  If negative practices are not identified they cannot be rectified.

Communication:

This was one of my most frustrating hurdles.

I jumped them many times only to keep finding more at every turn, even right up to a few days before Mum passed away.

I asked many times about handovers between shifts and was told that it was electronic.

I proved to them numerous times that it was not working but still it continues to be that way.

It wasn’t just a problem from RNs to PCWs.  Many RNs (Registered Nurses) did not know what happened on the previous shift.  Yet they spent countless hours writing reports.

It would seem that no one talks to each other.

This is particularly so between the different layers of staff.

RNs do not talk to PCWs, Management does not talk to anyone.

And I don’t think anyone talks to the volunteers.

Communication to relatives is almost unknown, unless you are like me and demand meetings.

I asked many times to receive the Newsletter via email.

It would happen when I asked but not again until I asked again.  I suggested an email list of relatives but that seemed too hard.

There would be Residents’ meetings but never were invitations extended to relatives (even though I was EPOA for my mother and therefore could talk on her behalf).

I think this is an exercise for Accreditation.

Tick that box!

Examples:

• A few days before Mum died, even though she could hardly keep her eyes open, PCWs tried to get her up to go out to the Dining Room for meals. They had not been told that Mum was palliative. One caring PCW went immediately and put a butterfly on Mum’s door so that other PCWs would know.
• One afternoon just a few days before Mum passed away, we were waiting for the Doctor to come (the RN said that she would call him). A few hours later I went to the RN station and asked the afternoon shift RN and she replied that Mum’s doctor had just been, and she was unaware of him needing to visit Mum.  He had gone again.  Lack of communication again and what happened in the handover?
• A month or so back we had a blackout on a Friday night. The whole of Cairns was out.  The power came back on after about 90 minutes.  This was early February in Cairns – one of the hottest months in our calendar.  The next morning I went to visit Mum.  As soon as I walked into her room I noticed the heat and stuffiness.  I checked and the air-conditioner was turned off (probably went off with the power cut)).  The door to the outside was closed and locked.  I immediately asked a PCW to turn the air-conditioner back on (the remote was not in Mum’s room).

I took Mum out into the Residents lounge to play cards.

I put the overhead fan on.

I noticed that the main air-conditioner was also not working.

I told two PCWs at different times.  The first one said: ‘not my job’ and walked off.

I thought that ridiculous as she was working in those conditions.

The second one said that she would tell the RN as it was her responsibility to attend to it.  It did not get turned back on.  No maintenance people as it was the weekend.

Other residents came out of their rooms complaining about the heat so obviously, their air-conditioners were also not working.

• Obviously, there is no procedure for checking that air-conditioners are back working after a black-out.

That surely is Workplace Health and Safety!!

• When my father became ill not long before his death it was obvious to me that he was suffering from an infection of some variety. He was feverish, shaking, pale and obviously unwell.  I called the RN who said: ”I don’t know what’s wrong”.  I asked numerous times what his urine output was to which she kept replying ‘I don’t know’.  After a couple of times saying the same thing I lost my cool and told her to damn well find out.  There was no recorded output.  That was when I demanded an ambulance to take him to the hospital where he was diagnosed quite quickly with a very bad UTI and in fact a kidney infection.  This was the beginning of his demise.  Not good enough

There are many examples, but these are just a sample.

Another area of Communication that could be improved very easily and quickly is the distribution of the Newsletter to relatives.

It would be a simple task to gather the email address of the main contact for relatives when registering the person.

This could then go onto a database and each month the newsletter could be easily sent out to all those relatives on the data base, therefore keeping them in touch with the news of the facility.

I would imagine this would be particularly welcomed by family living away and having little other contact.

It would also be great if the Newsletter was a bit newsier with photos, jokes, and stories in it.

One point about communication – please don’t make it frustrating.

Almost every time I reported something that had happened, I was met with “That shouldn’t have happened!”.

I knew it shouldn’t have happened, that is why I was reporting it.

I knew it shouldn’t have happened, they know it shouldn’t have happened, but it happened and all I wanted was assurances that there would be a change of behaviour so that it didn’t happen again.

Something must change to ensure it doesn’t reoccur, not just words.

Meals:

This was an area that disgusted me quite often.  I was one of the few relatives who ever sat in the Dining Room at meal times and I was concerned that other relatives had no idea what was being served up to their loved ones.

I often took photographs and sent them to the Management (and to Facebook) to try to bring about improvement.

One night I drove to Hungry Jacks to get a hamburger for one of the men as he was served three small (quarter of a round) sandwiches.

He was a big man, no mental condition, and was hungry.

I was reprimanded for that but would do it again tomorrow rather than see a man go to bed hungry.

I am pleased to say that eventually the head cook (could not call him a Chef) left and the meals improved 300% afterwards.

Presentation is so very important.

Many residents do not eat enough so food that is appealing as well as nutritious is vital.

Don’t forget that Morning Tea, Afternoon tea and Supper are part of the resident’s eating experience also.

One cream biscuit on a piece of kitchen paper is not a nice Morning Tea.

Maybe some training in this area would be helpful.

There is a Chef there who cooks the most wonderful desserts for the residents.

They are the type that the ladies would have cooked themselves.

Rice puddings, Bread and Butter puddings etc.  So lovely for the residents.

Well done Chef.

Supervision:

This I think is one of the biggest issues.  If this occurred then hopefully a lot of the issues would disappear.

I spent many hours at this particular Aged Care facility yet very rarely saw any supervision happening.

I suggested many times that there should be a RN in the High Care dining rooms during meal times.

I was told by Head Office that this would happen, but it rarely did.  So much would have been seen by RNs if had bothered to be present and notice things.

Things that I frequently noticed were:

• residents not knowing how to feed themselves (once helped to get the first couple of spoonful in they were on a role)
• residents choking on food;
• residents being jerked awake when the back of their Regency Care Chair was yanked to the sitting position for feeding while the resident was fast asleep without any conversation to the resident;
• residents without teeth given meals that require chewing;
• residents who were soiled sitting at the meal table;
• residents not encouraged to eat or drink – food just taken away if they did not eat/drink it. (You are obviously not hungry)
• Many other sad issues were noticed but too many to list. I would often go away from there in tears thinking about the poor darlings.

PCWs are not medically trained and therefore on many occasions were not giving the care and attention that the resident required, due to lack of understanding and knowledge.

One of the more frustrating issues for me was the lack of understanding about the requirement to ensure that my mother drank throughout the day.

A jug and a glass were put in her room but with her dementia she never recognised hunger and thirst so needed someone to ensure that she had fluids.

Some PCWs understood this, but others were oblivious of the importance of this.

No supervision to ensure that this occurred.

Therefore frequent UTIs.

Telling PCWs to push fluids, especially those with English as a second language, seemed to confuse some of them.

Where we they to push it to?  Don’t make assumptions that the workers will understand, ensure that they do.

Kitchen staff place the water jugs in the rooms and collect them.  Who is noting if any water has been drunk?  This is particularly relevant during our warmer weather where dehydration can easily become an issue.

One day, not too long ago, I arrived and as I walked towards the Dining Rooms I heard a dispute between a resident and a PCW.

Both were speaking in raised voices.

As I got closer it would seem that the resident was pushing a chair out of the Dining Room on her way to her bedroom and the PCW was trying to stop her.

Both were frustrated.

This was happening right outside of the Nurses Station but neither of the RNs in there came out to assist.

The resident called out to me to help her.

I gave her a cuddle and calmed her down and asked her to sit down.  Then we walked her back to the Dining Table.  It just required a calm person to deactivate the situation.

Pity the RNs did not see that as their job.

I would have thought that RNs and Care Managers would have a role in supervision.

Training:

From my observation training of PCWs is a major chasm in the care of residents.

They do not have a medical background or training but are the only people, for the majority of the time, to lay eyes on the residents.

They are meant to report any medical problems to the RNs, but how do they know what is a problem?

I believe that everyone working as a PCW in Aged Care are required to have a Cert 3 in Aged Care.

– bit of a farce when the person can hardly speak English or comprehend English and most of the Residents are English speaking.

– Major gap in communication, particularly when most elderly residents have some hearing loss so understanding another accent can become almost impossible.

I also believe that there is no requirement for First Aid Certificate.

How can this be when they are carrying out the day-to-day care of vulnerable people who quite often have swallowing difficulties due to age and/or medical issues?

Ongoing training:

I am not sure what ongoing training happens, if any.

The only type of training that I witnessed was showing people where the fire walls were; however, during a fire alarm when I was present, very few staff members knew what to do.

I hate to think what would have resulted if it was a real fire.  It was not a practice but fortunately there was no fire, just a wire tripping.

It also seems obvious to me that the staff need updating, and reminding, of the need for nutrition and hydration of these elderly residents.

If the PCWs knew the reasons that they had to be observant and ensure that the residents had adequate hydration and nutrition, then the majority of them would respond with better care.

Another area which needs training for some PCWs is to do with Cultural differences.

Most of the residents are Caucasian Australians and a lot of the PCWs are multi-cultural.

Nothing wrong with that except where cultural practises of the residents are not adhered to by the staff.

For example:  Cups of tea served without a saucer.  A small thing, I realise, but important to the ladies, if they are to feel ‘at home’.

Talking of observation – this seem devoid most of the time.

Staff seem to just see what they want to see.

This is RNs, PCWs, cleaners etc. and even Management.

So many times I had to get quite forceful to have things noticed.

Managements answer to everything is to put up notices.  Notices everywhere but some people don’t take any notice of them, as they don’t also seem to read the Care Chart.

Examples: (these are examples of both lack of training and lack of supervision)

I vividly remember one day Dad (who did not have dementia at this stage) telling me that he did not have a shower that morning, instead he was hosed.

He told me that there was no other word for it – no soap, no face-washer, no anything but hosed with water.  He was indignant.  Although my father was incontinent, he was also a proud man and liked to be clean and tidy.

During our very hot summers I would often go into my mother’s room and it would be so hot and stuffy.

No air-conditioning or doors open.

How long before this had occurred no-one could tell me, but it was obviously some hours by the air in the room.

Surely staff going in and out of the room should have noticed, or didn’t they enter my mother’s room – which is another issue?

Yes Mum would turn the air-conditioner off, as she did the lights, the television and the air freshener.  I found the solution by taking the remote away but still some staff would occasionally turn it off until I put a sign there.

Another time I noticed a rash on my father’s forehead while visiting.

I reported it to a PCW who said that she would tell the RN.

Two days later the rash had spread all over the left side of his face.

I called an RN who told me that they didn’t know about the rash and she didn’t know what it was – ”I don’t know”. 

I said that I had reported it two days before to which she said: “No-one told me”.

Good Hand-over system!  Seemingly no-one had noticed even though Dad had an EN put eye drops in his eyes twice a day; had medication given to him several times a day; had a shave every morning – but it was all obviously done by braille as no-one looked at him.

Obviously no RN had been near him in those two days either.

Another memorable occasion was when I arrived to find Dad with a large wet patch on the front of his pants.  I called a PCW and asked the PCW to change Dad please.

Mum and I went out to the Lounge.

The male PCW then brought Dad out to join us in new pants.

I later went into Dad’s room for something and the bed still had a large wet patch on it.  My fault, I guess, I only asked him to change Dad and didn’t add the bed also.

I called him back to change the bed.

One day I went into Dad’s room (early December and very hot day) to find Dad slumped in his wheelchair, shaking uncontrollably; very pale and with a big cardigan over him.

I immediately took the cardigan off and said to the PCW that he is feverish.  She said in broken English “No, him cold, him shake”.

He had a massive Urinary Tract infection which then led on to kidney collapse.

Another day I went to call on Mum at lunch-time.

It was 11.25am.

She was already sitting at the Dining Room table (lunch is served after 12 noon).

As soon as I saw her I was livid.  Her hair had not been brushed; she did not have her dentures in and she smelt very bad.  (This was probably a month before she passed away).

I asked a PCW to call the Care Manager.

The Care Manager apologised but seemingly the PCW who was caring (?) for Mum could not find her denture.

She obviously could not find a brush or the shower also.

I was told that Mum had eaten a good breakfast.

Why do I not believe them? All the other PCWs and the ENs who had attended to, or who saw Mum that morning were also at fault.

No-one attended to her dignity.  How sad and disgraceful.

These are just a couple of examples.  There is a long list that is well documented. 

Dementia training

As dementia is present in a large portion of the population in an Aged Care facility, especially in High Care, I would have though Dementia training would be a given, but alas I was mistaken again.

When Mum was diagnosed with dementia I wanted to know as much as I could so that I not only understood what was happening with her but also how I could help.

I researched and found the University of Tasmania has an on-line course in Understanding Dementia.

I enrolled, and it was one of the best courses I have ever done in my life.

It gave me a comprehensive understanding of the different types of Dementia and all aspects of dealing with it.

I tried to encourage many staff members of the Aged Care facility to enrol, it is free.

Eventually, I believe, there were people brought in to run some Dementia training.

I don’t believe it was comprehensive enough as it seemed to concentrate on the aspects of behaviour problems in people with Dementia and there are far more aspects that need understanding.

However, I do commend Management for at least starting.

Demarcation: 

One of the most frustrating issues for relatives (and some residents).

As residents, or relatives of residents) we don’t really care whose job it is to do what or who’s the PCW designated to Mary (for example).

We just want some assistance for Mary.  If Mary is sick or has used her bowels in the bed/chair, we don’t want to wait for ‘her’ PCW to come back from her/his break.

I realise it is easier to track down who’s not performing by allocating residents to PCWs but there must be flexibility.

I acknowledge the PCWs who are flexible and will assist at any time, but others stick to the rules (when they suit them).

I saw so many examples of demarcation during the time I spent at this facility.  Most of the time, after I got used to how it works, I used to say: “Who is responsible for changing the dressings?”  or whatever needed doing.  Then I would ask for them to be called.

Other times I would simply say: “Ï don’t care whose job Dad/Mum is, just do it.”

The “Blame Game” is played quite often.  A number of PCWs are very concerned about getting into trouble’.

In Management I was aware that the Blame always rested with the Management as obviously the processes and/or supervision is not good enough.

Comments like:

“Not my job”; “Brenda is his carer today”; “The RNs/PCWs are supposed to do that”; “Mary was supposed to do that” is all too often heard.

If the Ethos was Resident Centred Care this would no longer be relevant!

Empathy:

I am very aware of the strain that working in such an environment must have on some staff.

This is similar in numerous professions.  Debriefing and staff meetings/training is a good way to deal with this sort of tension.

Does this support for staff happen?

When each of my parents passed away, I received lots of support from many of the PCWs who showed a lot of empathy for myself and my family.

I am sorry to say that this did not extend to staff of a higher level.

There were times when I was witness to some staff having no understanding of the confusion/mental state of a resident let alone display any empathy to the person.

I had a PCW say to me that “these people need to learn patience”.  I could not help myself and said, “No darling, it is you that needs to learn patience”.

In all workplaces there are some staff who are only there because it is a job with an income, however these people need to be encouraged to move along as the elderly residents are too precious to live their last days in the care of someone who really doesn’t care.

Community:

One of the areas that makes me sad, particularly as a daughter and a Community Development Worker, is the lack of community-building that happens in the Aged Care facility.

One of the reasons that I wanted Mum and Dad to move from their own home into the Aged Care facility was I could see that they were becoming socially-isolated.

As neither of them could drive any longer and their friends had either passed away or were in the same boat as they were, the only time they had company was when the home-help came (and Mum would talk to them instead of them doing the cleaning that they were meant to do, or when my daughter and her family or I went to visit or took them on an outing.

Every Thursday I took them to a local Shopping Centre for Morning Tea and quite regularly we were joined by a couple of their friends who were also dropped off by relatives.

My daughter, her husband and I were all working at this stage, so our time was limited.

I foolishly believed the advertising that told me that there was a sense of community in the Aged Care facilities.  There may be a sense of Community in the Low Care section but definitely not in High Care.

The only times that the residents get together is in the Dining room where a lot of them seem too intimidated to talk.

No encouragement of conversation.

In fact, I rarely saw a new person introduced to others. They are there to eat and hurry up as the room must be cleared by a certain time and there are jobs to do.

Diversional Therapists are nowhere to be seen.

A wonderful opportunity gone missing.

The other time when they get together is at activities where they are sat in rows to either hear a concert or play Bingo or Hoi.

To see a room full of people, even those asleep in Regency Chairs, ‘playing’ Bingo is nothing but a sad ‘tick the box’ for accreditation.

Social isolation should not be happening in these facilities.

There are many ways of encouraging chatter and interaction and you have a captive audience to work with.

My parents and I filled out a 4-page document (twice after the first one was lost) concerning Mum and Dad’s lives, hobbies, interests etc.

Not once do I believe that document was acted upon.

Mum and Dad were great card players.

I was told on numerous occasions that Mrs.

So-and-so likes to play cards but never were they introduced.  Again, an exercise for Accreditation.

I tried to initiate Men’s Happy hour where they could gather in one of the Lounges and watch a John Wayne DVD or similar, but to no avail.

I also suggested, many times, a partnership with local High Schools were the students must do some Community Service and the schools also have Orchestras and Choirs who could rehearse in front of the residents, a win-win situation.

This was never followed up on.

I do know this could happen as I used to work in the Regional Office of Education and had connections with all schools.

Some students could read to residents who no longer had good vision, some could talk to the residents, some could do craft.

There are many opportunities for cross-generational liaison.

When we sat in the Lounge playing cards we were often looked at, as we were often the only people who ever used the Lounge.

In our own home, we don’t play cards in our bedroom, we use the lounge so why wouldn’t activities be encouraged in the Lounge.

I did request a CD player for the Lounge (so we could have music playing while we played cards).  I am pleased to say that this was purchased.

I often encouraged others to come into the Lounge and sit and talk with us while we played.

The residents who did so loved the opportunity for the company and they got to talk to each other and make some friendships.  (some conversations were difficult for me to understand but they enjoyed them).

I often heard staff saying: “Back to your room Thelma”; “Come on Mary, back to your room” etc and yet there are signs around reminding staff that this is the Resident’s home.

Most ambulant people do not stay in their bedroom in their home.  That is what Living areas are for. 

Accreditation:

From my perspective, Accreditation is nothing more than a tick and flick exercise which causes a flurry for six months or so before the given date that it is to happen.

Prior to the Accreditation date the place is a hive of activity getting things ship-shape, Reports written, stock counted and Tick the boxes.

One day as I entered the High Care area there was a video playing and the majority of the High Care residents were lined up around the television.

I looked to see what they were watching.

It was a Presentation on Falls Prevention.

How ridiculous.

A good percentage of the audience were either not in the mental state to take this presentation in or were uncapable of moving anyway.  Another tick the box exercise.

I would suggest that the wrong audience were watching the presentation.  It should have been the staff.

At the time of the last Accreditation, I asked to have an interview with the Accreditors.  That seemed to be an unusual request.  However, I did achieve this but was left disappointed.

One of the subjects that I wanted to talk about was Nutrition.

At the time the meals left a lot to be desired.  I did make a comment about this subject and I was asked “Do they get three meals a day?” “Yes, they got three meals (?) a day but the quality and presentation of those meals were disgraceful.”

Didn’t seem to matter, as long as they were fed 3 times a day.

RNs in the Nurses Station writing reports constantly, yet when I would ask about Mum’s weight or something else the file notes could not be found – must be creative writing because they rarely visit the residents, and when they do in most cases it is a flying visit.

It would seem that for some RNs their ‘safe place’ is the Nurses’ station and they are uncomfortable away from there.

Finances:

Watch accounts very carefully.  I had many headaches and so many hours taken up with trying to make sense out of my parents’ accounts from the perspective of the Care Agency but also from Department of Veterans Affairs and Centrelink.

On two separate occasions I picked up discrepancies in their accounts and by questioning, and questioning, and questioning, I saved my parents a total of approximately $9,000 in total over the two occasions.

That is a lot of money over less than 4 years.  At one stage I had to contact the Ombudsman for assistance.

I am very concerned that other residents are just paying up without any idea that there could be discrepancies and/or do not have anyone with the ability or advocacy skills to do anything about it.

The problems with trying to achieve an acceptable outcome between Centrelink, DVA and the Care provider would make a very good Study Paper, but I do not want to go into that now.

Enough has been documented on it.

On the positive side:

On the whole Mum and Dad were quite happy at the facility. However, they did not know a lot of what went on behind the scenes, especially financially.

Dad would have been furious.

I wanted my parents to have the best experience they could, so did not worry them with the things that I could take care of.

Mum and Dad liked a lot of the PCWs and I was witness to a lot of lovely interaction between the PCWs and Mum and Dad.

I also experienced a pleasing rapport between myself and some of the regular PCWs.

There were times when I knew certain staff were on duty that I could completely relax knowing that my parents would be well cared for.

The facility is attractive with nice gardens.  It would be nice to see them utilised more.

Management and I built up quite a relationship and understanding when I requested regular meetings.

I also really loved to hear the sound of laughter in the facility.  Mostly it was fun between staff members but every now and then it would involve a resident as well.

Mum and Dad loved to have fun with the PCWs and it was so nice to hear laughter in the halls and rooms.

I realise that this reads as a fairly negative document, however there is so much that needs to be improved and most of them are not costly but attitudinal.  The difference would be in the care of the residents and the happiness of them.

Studies show that as many as 60% of residents in Aged Care facilities do not receive visitors.  That shook me to the core and I feel so sad for these people.

Possibly with more communication between the facility and the relatives, this sad percentage can be reduced.

My recommendations:

Ethos:

• Resident Centred Care – change of attitude and practise.
• Putting people before tasks.
• It is about the residents first and foremost

Advocacy:

• Listening to what people have to say.
• Watch body language when listening to people.
• Invite relatives to meet to discuss changes.

Communication:

• Break down the barriers to communication – Management to be more accessible and visible.
• Change of attitude towards people expressing their views
• Verbal handovers at the change of shift. Technology is obviously not working in this regard.
• Processes to be put in place and staff trained on them for emergency situations – power outages, fire emergencies
• Communication to relatives – newsletters emailed to them were possible.
• When a problem occurs ensure that there are changes to eliminate a reoccurrence – not just words.

Meals:

• Training in hospitality for those serving meals.
• A Chef who understand the likes of the older generation
• Ensure Morning and Afternoon teas are nutritious, attractive and enough as well as served nicely.
• Food to look attractive as well as be nutritious.

Supervision:

• There should be a RN observing in the High Care dining rooms during meal times
• Care must be taken with instructions when dealing with staff with English as a second language.
• Supervision must be unscheduled and often.
• Supervision should be seen a support for carrying out tasks, not as a fault-finding exercise.
• Supervision will reduce the number of complaints
• Supervisors will get to know the residents better, not just when they are sick or a problem.
• Closer supervision as to whether residents are drinking water – particularly in warm weather.
• All residents should be visited/checked by RNs on a regular basis.

Training:

• All PCWs must have a First-Aid Certificate (I worked in an Early Years Centre and everyone (office staff, Community Development Officer and volunteers all did the First Aide course)
• An Audit should be carried out as to the training of Cert 3 in Aged Care.
• Persons doing a Cert 3 in Aged Care must have a certain level of English language and comprehension
• Training emphasis on nutrition and hydration
• Fire awareness and evacuation procedures are frequently emphasised in training.
• Frequent ongoing training is necessary to curtail any bad practises.
• Training needs to be held on the importance of Care Charts and the adherence to such.
• Observation of the resident is an are which needs to be taught and taught again. So important especially when dealing with residents in High Care.
• Palliative care training for all staff

Dementia training:

• Statistics tell us that approximately 80% of people in High Care Aged Care facilities have a degree of dementia, it would be remiss to not have specific Dementia training as a necessity for staff.
• Brilliant free online training is available through the University of Tasmania.
• It is important for staff to know that there are many types of dementia and a range of abilities and disabilities within those types.

Demarcation:

• Introduce Resident Centred Care
• Stop the Blame Game unless there is a particularly lazy or negligent staff member.
• All staff should assist a resident in need. Or if something needs doing (eg a walker needs to be taken back to a resident’s room) then anyone walking past it should stop and take it to where it is needed.
• Supervision and communication are the keys here

 Empathy:

• A hard concept to teach.
• Debriefing and small discussion groups are helpful for people under stress.
• Supervision and observation should highlight those for whom it is just a job and there is no empathy.
• Those staff members should be encouraged to move on.
• Staff members exhibiting these skills should be thanked and rewarded for their good work.

Community:

• Social isolation is absolutely detrimental to residents and needs a lot of work to stamp out.
• Residents should not be in their rooms all day or plonked around a TV set.
• Activities suitable for different groups need to be organised and encouraged – not everyone being babysat by the one activity.
• Outside bodies can be invited to come into the facility to interact with the residents.
• More use can be made of gardens, lounges etc to encourage interaction between residents.
• Residents will be happier and less demanding if there are activities/interaction which keep them busy and are linked to their interests.

Accreditation:

• Accreditation is meant to be ensuring that the facility is consistently meeting regulation standards (not just when an Accreditation is about to happen)
• Tick the box exercises should be curtailed and meaningful ones instigated.
• Meaningful processes and protocols should eliminate a mad flurry prior to Accreditation time.

Finances:

• Worthwhile, frequent communication between all agencies involved in Income and Payments and Assets of people in Aged Care facilities to ensure as hassle-free accounting as possible.
• Relatives encouraged to check figures and dates etc on accounts. Supervision in the Accounts section also seems warranted.

On the positive side:

• There are some very good, caring staff. Identify and honour them with the purpose of keeping them.
• Laughter – joyful and good medicine to hear staff members laughing with each other and with residents.
• More fun and maybe dress-up days etc would cheer the residents up a lot.
• Encourage family members to build a pleasant rapport with some staff members
• Need to utilise the gardens more – Gazebos and seats for small chat groups etc
• Encourage relatives to have regular meetings with Management – not just meet when things are wrong. Keep relatives informed and encourage involvement thus encouraging regular visits.